Total ankle replacement (TAR) replaces a worn or damaged ankle joint with an artificial one. It is mainly used for severe ankle arthritis, to relieve pain while keeping movement in the ankle. I perform ankle replacements in London, at Guy’s and St Thomas’ and in private practice at HCA hospitals, using the Infinity ankle replacement with Prophecy CT-based planning. Below are answers to the questions patients ask me most often.
On this page
- Who is suitable for an ankle replacement?
- How does ankle replacement compare with ankle fusion?
- How is ankle replacement surgery performed?
- How much better will I feel?
- How long does an ankle replacement last?
- What are the risks of ankle replacement?
- Will I need more surgery?
- What is the recovery after ankle replacement?
- What rehabilitation will I need?
- When can I return to normal activities and sport?
- How reliable are these figures?
- How much does a private ankle replacement cost?
- Book a consultation in London
Who is suitable for an ankle replacement?
Ankle replacement is usually considered for people with severe ankle arthritis, or other damage to the joint, that is causing significant pain and limiting daily life despite simpler treatments such as painkillers, braces, injections or activity changes.
It works best in people with healthy bone and good circulation. It is not usually suitable if you have an active infection, poor blood supply to the leg, or nerve damage in the foot from diabetes.
The risk of the implant failing is higher in people who:
- Are younger, particularly under 65
- Have diabetes
- Are significantly overweight
- Have a severe ankle or foot deformity
- Have lung disease
- Drink heavily
This does not always rule out a replacement, but it is something we will discuss when weighing up your options.
How does ankle replacement compare with ankle fusion?
Ankle fusion joins the bones of the ankle together. It reliably relieves pain but removes movement at the joint.
A large UK trial (TARVA) found that both operations gave similar improvements in pain and function at one year. Overall, function is similar. A replacement keeps more movement in the ankle, while a fusion is less likely to need further operations. Early complications after replacement are as low as, or lower than, after fusion.
The right choice depends on your ankle, your health and what you want to be able to do. I explain the differences in more detail in my article on ankle replacement versus fusion.
How is ankle replacement surgery performed?
The operation is done under general anaesthetic. I make an incision at the front of the ankle, remove the damaged joint surfaces and replace them with metal components and a plastic bearing between them. Most people stay in hospital for one or two nights and go straight home afterwards.
I use the Infinity total ankle replacement with the Prophecy planning system. Before surgery, a CT scan of your ankle is used to plan the size and position of the implant and to make guides specific to your anatomy. This helps position and size the implant accurately. You can watch an animation of the operation here.
You can also read more about the surgery and any potential complications on this page.
How much better will I feel?
Most people have a large improvement in pain and day-to-day function. On average, function scores roughly double, from about 40 to 80 out of 100, and ankle movement improves. In one 10-year study, more than 4 in 10 people said they forget they have an artificial ankle.
Results vary between patients, implants and surgeons. Outcomes are better in hospitals that do more of these operations. On the National Joint Registry, I performed 23 ankle replacements in the year to March 2026, nearly three times the national average of 8.
How long does an ankle replacement last?
About 8 to 9 in 10 ankle replacements are still working 10 years after surgery. Roughly 1 in 100 fail each year, and joint registries show about 1 in 10 have been revised by seven years. How long yours lasts depends on factors such as your age, weight, activity level and the condition of your ankle. If a replacement wears out or loosens, it can be revised or converted to a fusion.
What are the risks of ankle replacement?
Most complications are minor and do not affect the final result. I will go through the risks with you in detail before surgery.
More common, usually minor:
- Small fracture of an ankle bone during surgery. About 1 in 10. This is usually fixed at the same time and does not change the recovery.
- Pain on the inner side of the ankle. About 1 in 10.
- Minor wound infection. About 7 in 100. This is usually treated with antibiotics.
- Wound healing problems. The skin at the front of the ankle is thin, so the wound needs care while it heals.
- Nerve irritation. This can cause numbness on the top of the foot, which is usually temporary.
Less common, more serious:
- Loosening of the implant. About 6 in 100. Further surgery may be needed.
- Deep infection. About 2 in 100. This usually needs further surgery.
- Blood clots. Fewer than 1 in 100. A clot in the calf (deep vein thrombosis) can travel to the lungs (pulmonary embolism). I assess your risk and may offer blood-thinning medication.
- Complex regional pain syndrome (CRPS). This is an uncommon long-lasting pain condition, with swelling, colour and temperature changes, and sensitivity in the foot. Most people with CRPS improve over time.
Will I need more surgery?
About 1 in 6 to 1 in 4 people have another procedure on the ankle in the long term. Most of these are smaller operations that keep the implant in place, such as clearing bone or scar tissue. A full revision of the implant is more likely after a replacement than after a fusion.
What is the recovery after ankle replacement?
For the first two weeks you will be in a cast and limited in how much weight you can put on the leg. After that you move into a walking boot and start physiotherapy and rehabilitation exercises. It takes several months to recover fully and return to normal activities.
What rehabilitation will I need?
Physiotherapy is an important part of recovery. A physiotherapist will guide you through exercises to improve movement, strength and balance, and to strengthen the muscles around the lower leg. You may use crutches and a walking boot while the ankle heals. How long you need physiotherapy depends on your progress.
When can I return to normal activities and sport?
Low-impact exercise such as walking, cycling, swimming and golf can usually start by around six months. Full recovery can take up to a year. High-impact sports such as running are not recommended with an ankle replacement, but a social game of tennis or a brisk hike is often fine.
How reliable are these figures?
The figures on this page are ranges from published studies and joint registries, not guarantees. Most of the evidence comes from observational studies rather than randomised trials, and results vary between patients, implants and surgeons. I will talk through your own risks and likely outcome at your consultation.
How much does a private ankle replacement cost?
Ankle replacement is available on the NHS. If you have private medical insurance, it is usually covered, but check with your insurer before your consultation. For patients paying for themselves, the total cost includes the surgeon’s and anaesthetist’s fees, the hospital stay, the implant and scans. Please contact us for a personalised quote.
Book a consultation in London
If ankle arthritis is limiting your life, I can assess whether an ankle replacement, a fusion or a non-surgical treatment is the best option for you. I see patients privately at HCA hospitals in London. Request an appointment or message us on WhatsApp.
